Advertisement

Intrapulmonary shear stress enhancement: A new therapeutic approach in acute myocardial ischemia

  • Sayed Nour
    Correspondence
    Corresponding author at: Laboratory of Biosurgical Research (Alain Carpentier Foundation), Pompidou Hospital, 56 rue Leblanc, 75015 Paris, France.
    Affiliations
    Laboratory of Biosurgical Research (Alain Carpentier Foundation), Pompidou Hospital, University Paris Descartes, 75015 Paris, France

    Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Daya Yang
    Affiliations
    Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Gong Dai
    Affiliations
    Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Qinmei Wang
    Affiliations
    Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Minze Feng
    Affiliations
    Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Nermine Lila
    Affiliations
    Laboratory of Biosurgical Research (Alain Carpentier Foundation), Pompidou Hospital, University Paris Descartes, 75015 Paris, France
    Search for articles by this author
  • Juan Carlos Chachques
    Affiliations
    Laboratory of Biosurgical Research (Alain Carpentier Foundation), Pompidou Hospital, University Paris Descartes, 75015 Paris, France
    Search for articles by this author
  • Guifu Wu
    Affiliations
    Division of Cardiology and the Key Laboratory on Assisted Circulation, Ministry of Health of China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Search for articles by this author

      Abstract

      Objective

      Ischemic heart disease (IHD) is a leading cause of mortality with insufficient results of current therapies, most probably due to maintained endothelial dysfunction conditions. Alternatively, we propose a new treatment that promotes endothelial shear stress (ESS) enhancement using an intrapulmonary pulsatile catheter.

      Methods

      Twelve piglets, divided in equal groups of 6: pulsatile (P) and non-pulsatile (NP), underwent permanent left anterior descending coronary artery ligation through sternotomy. After 1 h of ischemia and heparin injection (150 IU/kg): in P group, a pulsatile catheter was introduced into the pulmonary trunk and pulsated intermittently over 1 h, and irrespective of heart rate (110 bpm). In NP group, nitrates were given (7 ± 2 mg/kg/min) for 1 h.

      Results

      In P group all 6 animals survived ischemia for 120 min, but in NP group only 2 animals survived. The 4 animals that died during the experiment in NP group survived for 93 ± 14 min. Hemodynamics and cardiac output (CO) were significantly improved in P group compared with NP group: CO was 0.92 ± 0.15 vs. 0.52 ± 0.08 in NP group (L/min; p < 0.05), respectively. Vascular resistances (dynes.s.cm−5/kg) were significantly (p < 0.05) lower in P group versus NP group: pulmonary resistance was 119 ± 13 vs. 400 ± 42 and systemic resistance was 319 ± 43 vs. 1857 ± 326, respectively. Myocardial apoptosis was significantly (p < 0.01) lower in P group (0.66 ± 0.07) vs. (4.18 ± 0.27) in NP group. Myocardial endothelial NO synthase mRNA expression was significantly (p < 0.01) greater in P group (0.90 ± 0.09) vs. (0.25 ± 0.04) in NP group.

      Conclusions

      Intrapulmonary pulsatile catheter could improve hemodynamics and myocardial contractility in acute myocardial ischemia. This represents a cost-effective method, suitable for emergency setting as a first priority, regardless of classical coronary reperfusion.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Saba M.M.
        • Ventura H.O.
        • Saleh M.
        • Mehra M.R.
        Ancient Egyptian medicine and the concept of heart failure.
        J Card Fail. 2006; 12: 416-421
        • Thom Th.
        • Haase N.
        • Rosamond W.
        • et al.
        Heart Disease and Stroke Statistics—2006 Update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2006; 113: 85-151
        • Matsuzawa Y.
        • Sugiyama S.
        • Sugamura K.
        • et al.
        Digital assessment of endothelial function and ischemic heart disease in women.
        J Am Coll Cardiol. 2010; 55: 1688-1696
        • Shiekh G.A.
        • Ayub T.
        • Khan S.N.
        • Dar R.
        • Andrabi K.I.
        Reduced nitrate level in individuals with hypertension and diabetes.
        J Cardiovasc Dis Res. 2011; 2: 172-176
        • Petrovic D.
        • Zorc-Pleskovic R.
        • Zorc M.
        Apoptosis and proliferation of cardiomyocytes in heart failure of different etiologies.
        Cardiovasc Pathol. 2000; 9: 149-152
        • Stary H.C.
        • Chandler A.B..
        • Dinsmore R.E.
        • et al.
        A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association.
        Circulation. 1995; 92: 1355-1374
        • Mathur R.K.
        Role of diabetes, hypertension, and cigarette smoking on atherosclerosis.
        J Cardiovasc Dis Res. 2010; 1: 64-68
        • Antoniucci D.
        • Valenti R.
        • Migliorini A.
        • et al.
        Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty.
        Am J Cardiol. 2002; 89: 1248-1252
        • Meier B.
        • Bachmann D.
        • Luscher T.
        25 years of coronary angioplasty: almost a fairy tale.
        Lancet. 2003; 361: 527
        • Johnson W.D.
        • Brenowitz J.B.
        • Saedi S.F.
        • Kayser K.L.
        Surgical management of end stage coronary disease.
        Adv Cardiol. 1998; 36: 118-126
        • Chachques J.C.
        Cellular cardiac regenerative therapy in which patients?.
        Expert Rev Cardiovasc Ther. 2009; 7: 911-919
        • Unger F.
        • Chmelizek F.
        • Jungwirth W.
        • et al.
        Artificial heart and cardiac transplantation: report on the first European combined procedure.
        Artif Organs. 1988; 12: 51-55
        • Krumholz H.M.
        • Anderson J.L.
        • Bachelder B.L.
        • et al.
        ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to develop performance measures for ST-elevation and non-ST-elevation myocardial infarction): developed in collaboration with the American Academy of Family Physicians and the American College of Emergency Physicians: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine.
        Circulation. 2008; 118: 2596-2648
        • Morgan J.M.
        • Honey M.
        • Gray H.H.
        • Belcher P.
        • Paneth M.
        Angina pectoris in a case of Takayasu's disease: revascularization by coronary ostioplasty and bypass grafting.
        Eur Heart J. 1987; 8: 1354-1358
        • Crea F.
        • Kaski J.C.
        • Maseri A.
        Key references on coronary artery spasm.
        Circulation. 1994; 89: 2442-2446
        • Moideen I.
        • Nair S.G.
        • Cherian A.
        Anomalous origin of the left coronary artery from the right pulmonary artery complicating a case of coarctation of the aorta.
        J Cardiothorac Vasc Anesth. 2004; 18: 327-331
        • Newburger J.W.
        • Takahashi M.
        • Gerber M.A.
        • et al.
        Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.
        Circulation. 2004; 110: 2747-2771
        • Haji S.A.
        • Movahed A.
        Right ventricular infarction–diagnosis and treatment.
        Clin Cardiol. 2000; 23: 473-482
        • Abrams J.
        A reappraisal of nitrate therapy.
        JAMA. 1988; 259: 396-401
        • Jacobson K.M.
        • Hall Long K.
        • McMurtry E.K.
        • Naessens J.M.
        • Rihal C.S.
        The economic burden of complications during percutaneous coronary intervention.
        Qual Saf Health Care. 2007; 16: 154-159
        • Berger P.B.
        • Tuttle R.H.
        • Holmes Jr., D.R.
        • et al.
        One-year survival among patients with acute myocardial infarction complicated by cardiogenic shock, and its relation to early revascularization: results from the GUSTO-I trial.
        Circulation. 1999; 99: 873-878
        • Gershlick T.
        • Thomas M.
        PCI or CABG: which patients and at what cost?.
        Heart. 2007; 93: 1188-1190
        • van den Brule J.M.
        • Noyez L.
        • Verheugt F.W.
        Risk of coronary surgery for hospital and early morbidity and mortality after initially successful percutaneous intervention.
        Interact Cardiovasc Thorac Surg. 2005; 4: 96-100
        • Kapur A.
        • De Palma R.
        Mortality after myocardial infarction in patients with diabetes mellitus.
        Heart. 2007; 93: 1504-1506
        • Schmitto J.D.
        • Kolat P.
        • Ortmann P.
        • Popov A.F.
        • Coskun K.O.
        • Friedrich M.
        Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease.
        J Cardiothorac Surg. 2009; 4: 52
        • Schmauss D.
        • Weis M.
        Cardiac allograft vasculopathy: recent developments.
        Circulation. 2008; 117: 2131-2141
        • Hatzopoulos A.K.
        • Rosenberg R.D.
        Embryonic development of the vascular system.
        in: Ware A. Simons M. Angiogenesis and cardiovascular disease. Oxford University Press, Inc./UK, Oxford1999: 3-29
        • al-Ghazali W.
        • Chita S.K.
        • Chapman M.G.
        • Allan L.D.
        Evidence of redistribution of cardiac output in asymmetrical growth retardation.
        Br J Obstet Gynaecol. 1989; 96: 697-704
        • Gokce N.
        • Keaney Jr., J.F.
        • Hunter L.M.
        • et al.
        Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease.
        J Am Coll Cardiol. 2003; 41: 1769-1775
        • Targonski P.V.
        • Bonetti P.O.
        • Pumper G.M.
        • Higano S.T.
        • Holmes Jr., D.R.
        • Lerman A.
        Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events.
        Circulation. 2003; 107: 2805-2809
        • Nour S.
        • Dai G.
        • Carbognani D.
        • et al.
        Intrapulmonary shear stress enhancement: a new therapeutic approach in pulmonary arterial hypertension.
        Pediatr Cardiol. 2012; 33: 1332-1342
        • Letsou G.V.
        • Franco K.L.
        • Detmer W.
        • et al.
        Pulmonary artery balloon counterpulsation: safe after peripheral placement.
        Ann Thorac Surg. 1993; 55: 741-746
        • Nour S.
        • Wu G.
        • Zhensheng Z.
        • Chachques J.C.
        • Carpentier A.
        • Payen D.
        The forgotten driving forces in right heart failure: concept and device.
        Asian Cardiovasc Thorac Ann. 2009; 17: 525-530
        • Nour S.
        Flow and Rate: Concept and clinical applications of a new hemodynamic theory.
        in: Misra A.N. Biophysics. Intech, Rijeka2012: 19-76
        • Jones S.P.
        • Bolli R.
        The ubiquitous role of nitric oxide in cardioprotection.
        J Mol Cell Cardiol. 2006; 40: 16-23
        • Ignarro L.J.
        • Napoli C.
        • Loscalzo J.
        Nitric oxide donors and cardiovascular agents modulating the bioactivity of nitric oxide: an overview.
        Circ Res. 2002; 90: 21-28
        • Loke K.E.
        • Messina E.J.
        • Shesely E.G.
        • Kaley G.
        • Hintze T.H.
        Potential role of eNOS in the therapeutic control of myocardial oxygen consumption by ACE inhibitors and amlodipine.
        Cardiovasc Res. 2001; 49: 86-93
        • Mital S.
        • Barbone A.
        • Addonizio L.J.
        • et al.
        Endogenous endothelium-derived nitric oxide inhibits myocardial caspase activity: implications for treatment of end-stage heart failure.
        J Heart Lung Transplant. 2002; 21: 576-585
        • Walsh J.H.
        • Bilsborough W.
        • Maiorana A.
        • et al.
        Exercise training improves conduit vessel function in patients with coronary artery disease.
        J Appl Physiol. 2003; 95: 20-25
        • Loscalzo J.
        N-Acetylcysteine potentiates inhibition of platelet aggregation by nitroglycerin.
        J Clin Invest. 1995; 76: 703-708
        • Calvert J.W.
        • Lefer D.J.
        Myocardial protection by nitrite.
        Cardiovasc Res. 2009; 83: 195-203
        • Elrod J.W.
        • Greer J.J.
        • Lefer D.J.
        Sildenafil-mediated acute cardioprotection is independent of the NO/cGMP pathway.
        Am J Physiol Heart Circ Physiol. 2007; 292: H342-H347
        • Halcox J.P.
        • Schenke W.H.
        • Zalos G.
        • et al.
        Prognostic value of coronary vascular endothelial dysfunction.
        Circulation. 2002; 106: 653-658
        • Heitzer T.
        • Schlinzig T.
        • Krohn K.
        • Meinertz T.
        • Munzel T.
        Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease.
        Circulation. 2001; 104: 2673-2678
        • Packer M.
        What causes tolerance to nitroglycerin? The 100 year old mystery continues.
        J Am Coll Cardiol. 1990; 16: 932-935
        • Nakano A.
        • Liu G.S.
        • Heusch G.
        • Downey J.M.
        • Cohen M.V.
        Exogenous nitric oxide can trigger a preconditioned state through a free radical mechanism, but endogenous nitric oxide is not a trigger of classical ischemic preconditioning.
        J Mol Cell Cardiol. 2000; 32: 1159-1167
        • Duncker D.J.
        • Bache R.J.
        Regulation of coronary blood flow during exercise.
        Physiol Rev. 2008; 88: 1009-1086
        • Brutsaert D.L.
        Cardiac endothelial-myocardial signaling: its role in cardiac growth, contractile performance, and rhythmicity.
        Physiol Rev. 2003; 83: 59-115
        • Thomas D.D.
        • Liu X.
        • Kantrow S.P.
        The biological lifetime of nitric oxide: implications for the perivascular dynamics of NO and O2.
        Proc Natl Acad Sci U S A. 2001; 98: 355-360
        • Nour S.
        • Dai G.
        • Wang Q.
        • Wang F.
        • Chachques J.C.
        • Wu G.F.
        The forgotten driving forces in right heart failure (part II): experimental study.
        Asian Cardiovasc Thorac Ann. 2012; 20: 646-657
        • Hughes G.C.
        • Post M.J.
        • Simons M.
        • Annex B.H.
        Translational physiology: porcine models of human coronary artery disease: implications for preclinical trials of therapeutic angiogenesis.
        J Appl Physiol. 2003; 94: 1689-1701
        • Allen B.S.
        Pediatric myocardial protection: where do we stand?.
        J Thorac Cardiovasc Surg. 2004; 128: 11-13
        • Gorge G.
        • Schmidt T.
        • Ito B.R.
        • Pantely G.A.
        • Schaper W.
        Microvascular and collateral adaptation in swine hearts following progressive coronary artery stenosis.
        Basic Res Cardiol. 1989; 84: 524-535
        • Pelc L.R.
        • Gross G.J.
        • Warltier D.C.
        Preferential increase in subendocardial perfusion produced by endothelium dependent vasodilators.
        Circulation. 1987; 76: 191-200
        • Yu X.
        • Kennedy R.H.
        • Liu S.J.
        JAK2/STAT3, not ERK1/2, mediates interleukin-6-induced activation of inducible nitric-oxide synthase and decrease in contractility of adult ventricular myocytes.
        J Biol Chem. 2003; 278: 16304-16309
        • Heinzel F.R.
        • Gres P.
        • Boengler K.
        • et al.
        Inducible nitric oxide synthase expression and cardiomyocyte dysfunction during sustained moderate ischemia in pigs.
        Circ Res. 2008; 103: 1120-1127
        • Busch T.
        • Sirbu H.
        • Zenker D.
        • Dalichau H.
        Vascular complications related to intraaortic balloon counterpulsation: an analysis of ten years experience.
        Thorac Cardiovasc Surg. 1997; 45: 55-59
        • Dangas G.
        • Mehran R.
        • Kokolis S.
        • et al.
        Vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus arteriotomy closure devices.
        J Am Coll Cardiol. 2001; 38: 638-641
        • Chachques J.C.
        • Duarte F.
        • Cattadori B.
        • et al.
        Angiogenic growth factors and/or cellular therapy for myocardial regeneration: a comparative study.
        J Thorac Cardiovasc Surg. 2004; 128: 245-253
        • Bolli R.
        Cardioprotective function of inducible nitric oxide synthase and role of nitric oxide in myocardial ischemia and preconditioning: an overview of a decade of research.
        J Mol Cell Cardiol. 2001; 33: 1897-1918
        • Vroom M.B.
        • van Wezel H.B.
        Myocardial stunning, hibernation, and ischemic preconditioning.
        J Cardiothorac Vasc Anesth. 1996; 10: 789-799
        • Zhang Y.
        • He X.
        • Chen X.
        • et al.
        Enhanced external counterpulsation inhibits intimal hyperplasia by modifying shear stress responsive gene expression in hypercholesterolemic pigs.
        Circulation. 2007; 116: 526-534
        • Falase B.
        • Easaw J.
        • Youhana A.
        The role of nicorandil in the treatment of myocardial ischaemia.
        Expert Opin Pharmacother. 2001; 2: 845-856
        • Gloekler S.
        • Meier P.
        • de Marchi S.F.
        • et al.
        Coronary collateral growth by external counterpulsation: a randomised controlled trial.
        Heart. 2010; 96: 202-207